Longitudinal integrated clerkships: a hermeneutic literature review

The longitudinal integrated clerkship (LIC) approach to medical education, offering students sustained, immersive clinical experiences, is in stark contrast with traditional block rotations. Although evidence shows that LICs are an effective way of educating medical students, much is still unknown on why or how this is so. This hermeneutic review of the literature aimed to produce a synthesis of the pedagogical understanding of LICs by addressing questions about the principles and philosophies of LICs, their intended outcomes, and how student learning is different in LICs compared with more traditional pedagogical structures. This review of 70 peer-reviewed publications identified three core principles underpinning LICs: continuity, meaningful relationships, and immersion in clinical and community settings. These factors may contribute to transformative learning in the form of deeper clinical reasoning, greater patient-centredness, and increased social accountability. Within LICs, the development of long-term, meaningful relationships with the clinical teams in which students are embedded and with patients could be important in fostering the understanding that dealing with patients is an organic, complex process rather than a straightforward mechanistic one. This provides the potential benefit of producing doctors who are more aligned to patient, societal and healthcare needs. The review highlights that LICs could be well-positioned to meet the evolving expectations of modern medical education by producing patient-centred, adaptable, reflective and socially accountable graduates who have the ability to deal flexibly with uncertainty and to be life-long learners.